Rotator Cuff Tear Arthropathy

Anatomy:

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. The rotator cuff is made up of four muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. 

Causes:

Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus then moves upward, out of the socket, and rubs against the acromion. This can damage the surfaces of the bones, causing arthritis to develop.

The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.

Imaging:

Rotator cuff tear arthropathy can be diagnosed on x-rays, which will show a rise of the ball (humeral head) towards the acromion and possibly some bone spurs (osteophytes). Sometimes, a CT or MRI scan is necessary to determine the bone quality and extent of arthritis and quality of the rotator cuff.

Treatment:

Nonsurgical Treatment
As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical. Your doctor may recommend the following treatment options:

• Rest or modifying your activities to avoid aggravation of symptoms.
• Physical therapy exercises to try and improve the range of motion in your shoulder.
• Nonsteroidal anti-inflammatory medications (NSAIDs), such as Aleve or ibuprofen, to reduce inflammation and pain. 
• Steroid injections in the shoulder can reduce the inflammation and pain, however, the effect is often temporary.
• Heat and/or ice for 20-30 minutes at a time.

Surgical Treatment

Unfortunately, rotator cuff tears and arthritis cannot heal or completely “go away” with conservative treatment, so surgery is an option when nonsurgical treatment has failed. If this is needed, Dr. Fleager will refer you to one of her partners who has subspecialty training in shoulder replacements. In cases of rotator cuff arthropathy, a reverse total shoulder replacement (arthroplasty) is indicated. In a reverse shoulder replacement, the socket and metal ball are opposite a conventional total shoulder arthroplasty. The metal ball is fixed to the glenoid (socket) and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for people with rotator cuff tear arthropathy because it relies on different muscles — the deltoid, not the rotator cuff — to move the arm.

Recovery: Most people spend at least one night in the hospital in order to closely monitor your status and provide great care after surgery. Typically, you will wear a sling for 4 weeks to avoid any shoulder range of motion. It is okay to perform elbow/wrist/hand range of motion during this time.

Physical therapy: You will participate in physical therapy for approximately 8-12 weeks to improve shoulder range of motion and strength.